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CNN Saturday Morning News

Interview With Dr. Sandra Fryhofer

Aired July 13, 2002 - 08:17   ET


MILES O'BRIEN, CNN ANCHOR: All right, this week there was some new research about hormone replacement therapy. It raised some concerns for women nationwide. A study finds the combination of estrogen and progestin -- I'm not sure I said that right -- we can ask our experts in a minute -- increases the risk of breast cancer, heart disease and even strokes. Our medical unit has been flooded with questions.

This morning CNN medical correspondent Elizabeth Cohen is in Washington -- Elizabeth, good to see you.


O'BRIEN: And Dr. Sandra Adamson (ph)...


O'BRIEN: Fryhofer. Why don't you guys just introduce yourselves and talk amongst yourselves.

FRYHOFER: It's Saturday morning, right? You can call me Dr. Sandy, OK? We'll make it easy for you.

O'BRIEN: Dr. Sandy, good to see you.

Who would like to go first, since you guys are driving this segment? Why don't you go, doctor? Tell me about this. Give me the big picture for those of us who missed the study.

FRYHOFER: All right, Miles.

Well, this is really big news for any woman who is ever even thinking about taking hormone therapy. And it's especially important for the six million American women that are taking the combination of estrogen and progestin.

Let me tell you what happened.

Earlier this week the NIH actually called off a major study group of the Women's Health Initiative and they told these women to stop taking their study drug. And these included the women that were taking the estrogen-progestin combination. And they did this because they found that this combination of estrogen and progestin actually increased the risk of heart disease, breast cancer and stroke. And so they told the women to stop it.

Now, this does not include women taking estrogen only, just the combination of estrogen and progestin.

O'BRIEN: Elizabeth, do you have a question from some of the e- mails you've been getting? Is that what it is?

COHEN: Well, you know what the question that I just hear all the time, Miles, is what do we do now? I mean there's six million women who -- there you go, and there you can see it in big letters -- six million women taking...

O'BRIEN: Underscoring the point.

COHEN: Underscoring the point. Six million women are taking this estrogen-progestin combination and I mean, you know, my own mother is asking me what am I supposed to do? Many women like these. They say that it's helped with the symptoms of menopause. It's given them sort of an overall sort of feeling better kind of feeling.

The answer is talk to your doctor. But really that's not enough of an answer, because your doctor has just heard about this, as well. The answer is that you need to think about exactly what the risks are. And actually we have that in the form of a question. Let's see if we can put that up.

"Exactly how risky is" -- there we go -- "Exactly how risky are these drugs?" That's the question that every woman needs to ask herself.

There are several different ways of looking at the risks. I'm going to put it in two ways.

First, let's look at it in one, in a big picture way. If 10,000 women were given these drugs, you would see eight extra cases of breast cancer, in other words, eight cases you wouldn't have seen without the drugs. And the numbers are the same for the other three illnesses, eight extra cases of blood clots, eight extra cases of heart disease and eight extra cases -- heart disease, blood clots, breast cancer and I'm forgetting one.

O'BRIEN: You know what? Let's put...

COHEN: Perhaps Dr. Sandy can tell me.

O'BRIEN: Let's put the graphic up to help you out in this, Elizabeth.


O'BRIEN: We have -- here's our little risk graphic. Shall we put that in the, Dee? There you go.

All right, heart attacks, up 29 percent. Breast cancer, up...

COHEN: Well, actually, I think -- O'BRIEN: No?

COHEN: Yes, and strokes up...

O'BRIEN: Yes? No?

COHEN: Well, although I think this is not the way to look at the...

FRYHOFER: Well, what this is, is this is actually like...

COHEN: This is not the way to look at it, I think. This is true. This is accurate. But I think this is not the way to look at it. If that, this, these are raw numbers. If you take the risk down to any individual woman, the risk increases half a percent per year, half of one percent per year.

O'BRIEN: So forget those numbers? All right, listen...

COHEN: I wouldn't say forget them. I would just say that those are -- that is a large, looking at it from a large picture. If you want to look at it as your own risk, it increases half a percent per year for each of those diseases that we talked about.

O'BRIEN: All right, Dr. Sandy, let's try to sort through the confusion here. Is this one of these things that, you know, it's like some of those cancer studies where they inject so much stuff into a laboratory rodent that it just doesn't really correlate to normal life? The methodology of the study, is it such that we should really listen?

FRYHOFER: Yes, Miles. This is a great study. In fact, this Women's Health Initiative is one of the best and biggest studies of its kind. As far as studies are concerned, they don't get any better. And this answers a question that all women ask -- should I or should I not take hormone replacement therapy? And now we know the answer, that for combination hormones the answer is no.

Now, what Elizabeth was talking about is important. When we looked at that first graphic with the 29 percent increased risk of heart attack, the 26 percent increase of breast cancer, the 41 percent increase in stroke, that was looking at an entire population. And as Elizabeth pointed out, when you look at the individual woman, the risk is smaller, but it's definitely there. So women needed to have this information.

But, again, it applies only to the estrogen-progestin combination. It doesn't apply to estrogen alone.

So to answer your question, Elizabeth, what are doctors telling their patients? Well, remember the study went on for -- they stopped it after fife years. It was supposed to go on for eight and a half years. But this risk of breast cancer didn't really start up until after four years. So for women that are wanting to take hormones for those hot flashes, just to get through that little, get to the top of the mountain so they can sleep and feel better, we're still OK. Women need to understand the risk and benefits, but when it comes to the hot flashes, you can take the hormones for a short time. But it's the long-term use that we now know about. The duration of use is the key and we now know that to prevent heart disease, to prevent stroke, hormones aren't the answer. We have other things we can do, but hormones aren't the way to go -- at least the combination hormones.

O'BRIEN: All right, Elizabeth has one more question.

COHEN: Well, I just wanted to clarify something there. In fact, heart disease did show up in the first year of the study. In just one year they did see an increase in heart disease. Not in the other three, but in heart disease they did after just one -- within that first year.

I'd like to sort of clarify something a little bit. I don't think that the answer is no. I don't think that the answer is -- if the question is should women get off, I don't think the answer is absolutely no. I've talked to many OB-GYNs over the past week who said, you know what? It's different for every woman.

If a woman is debilitated by the symptoms of menopause and she knows what the risks are and she's willing to take those risks, I would keep her on those drugs. Just as Dr. Sandy said, if a woman's taking it because she thinks it's going to decrease her risk of heart disease or breast cancer or the other illnesses, then no. Then she ought to get off of them.

O'BRIEN: All right.

COHEN: But for some women, this may be something they want to continue, if they know what the risks are.

O'BRIEN: All right, ladies, we're going to have to leave it at that. We're going to have to get off this segment and move on.

FRYHOFER: Are you getting too hot? Are you too hot this morning?

O'BRIEN: Yes. We're going to get off and move along.

Elizabeth Cohen, Dr. Sandy, thank you so much.

FRYHOFER: All right.

O'BRIEN: I'm sorry about bollixing everything up here this morning.

FRYHOFER: That's OK, Miles.

O'BRIEN: I'm doing the best I can. I'm just a humble little anchor here.